PHARMACY AND THERAPEUTICS COMMITTEE AGENDA Date of Posting

229 Pages·2015·2.31 MB·English

STATE OF NEVADA
DEPARTMENT OF HEALTH AND HUMAN SERVICES
RICHARD WHITLEY,
DIVISION OF HEALTH CARE FINANCING AND POLICY MS
Director
1100 E. William Street, Suite 101
Carson City, Nevada 89701
BRIAN SANDOVAL MARTA JENSEN
Governor [phone] • Fax [phone] Acting Administrator

NOTICE OF PUBLIC MEETING – PHARMACY AND THERAPEUTICS COMMITTEE

AGENDA

Date of Posting: xxxxx

Date of Meeting: Thursday, December 3, 2015 at 1:00 PM

Name of Organization: The State of Nevada, Department of Health and Human
Services, Division of Health Care Financing and Policy
(DHCFP), Pharmacy and Therapeutics Committee.

Place of Meeting: JW Marriott – Las Vegas
Marbella Room
221 N. Rampart Blvd
Las Vegas, NV 89145
Phone: [phone]
Please check with hotel staff to verify room location

A visual and audio feed will also be broadcast via the
internet and phone for those who are unable to attend in
person. See below for details.

Webinar Pre-Registration:
https://catamaranrx.webex.com/catamaranrx/onstage/g.php
?MTID=e6caebf863da965b41ca7ba5f5a4c5731

**Must Pre-Register**

Once you have registered for the meeting, you will
receive an email message confirming your registration.
This message will provide the information that you need
to join the meeting
Webinar Event:
https://catamaranrx.webex.com/catamaranrx/onstage/g.php
?MTID=e6caebf863da965b41ca7ba5f5a4c5731

Event Number: 740 124 858
September 28, 2015
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Follow the instructions that appear on your screen to
join the teleconference.

Teleconference: 1 [phone]

Access Code: 3844816

Reasonable efforts will be made to assist and accommodate physically challenged persons desiring to
attend the meeting. Please call Tanya Benitez at: 775-684-3722 or email [email protected]
in advance, but no later than two working days prior to the meeting, so that arrangements may be
conveniently made.
Items may be taken out of order.
Items may be combined for consideration by the public body.
Items may be pulled or removed from the agenda at any time.

Public comment is limited to 5 minutes per individual, organization, or agency, but may be extended
at the discretion of the Chairperson.

AGENDA

1. Call to Order and Roll Call

2. Public Comment

No action may be taken on a matter raised under this item of the agenda until the matter itself
has been specifically included on the agenda as an item upon which action can be taken.

3. Administrative

A. For Possible Action: Review and Approve Meeting Minutes from September 23,
2015.

B. Status Update by DHCFP
1.Public Comment

4. Annual Review – Drug Classes Without Proposed Changes From September 23,
2015 Meeting
A. Public Comment
Nevada Department of Health and Human Services
Helping People -- It's Who We Are And What We Do
September 28, 2015
Page 3
B. Presentation of Recommendations for Preferred Drug List (PDL) inclusion by
OptumRx and the Division of Health Care Financing and Policy without
Changes.
C. For Possible Action: Committee Discussion and Approval of Drugs for
Inclusion on the PDL
1. Tramadol And Related Drugs
2. Non-Sedating H1 Blockers
3. Inhaled Aminoglycosides
4. Antivirals - Alpha Interferons
5. Anti-Hepatitis Agents – Polymerase Inhibitors/Combination
Products
6. Anti-Hepatitis Agents – Protease Inhibitors
7. Anti-Hepatitis Agents – Ribavrins
8. Anti-Herpetic Agents
9. Influenza Agents
10. Second-Generation Cephalosporins
11. Third-Generation Cephalosporins
12. Macrolides
13. Quinolones - 2nd Generation
14. Quinolones - 3rd Generation
15. Self-Injectable Epinephrine
16. Multiple Sclerosis Agents - Specific Symptomatic Treatment
17. Angiotensin Ii Receptor Antagonists
18. Angiotensin-Converting Enzyme Inhibitors (ACE Inhibitors)
19. Calcium-Channel Blockers
20. Direct Renin Inhibitors
21. Vasodilators – Inhaled
22. Bile Acid Sequestrants
23. Cholesterol Absorption Inhibitors
24. Fibric Acid Derivatives
25. Hmg-Coa Reductase Inhibitors (Statins)
26. Niacin Agents
27. Antipsoriatic Agents - Topical Vitamin D Analogs
28. Topical Analgesics
29. Acne Agents: Topical, Benzoyl Peroxide, Antibiotics And
Combination Products
30. Impetigo Agents: Topical
31. Topical Antivirals
32. Topical Scabicides
33. Immunomodulators: Topical
34. Topical Retinoids
Nevada Department of Health and Human Services
Helping People -- It's Who We Are And What We Do
September 28, 2015
Page 4
35. Serotonin-Receptor Antagonists/Combo
36. H2 Blockers
37. Proton Pump Inhibitors (PPIs)
38. Gastrointestinal Antiinflammatory Agents
39. Gastrointestinal Enzymes
40. 5-Alpha Reductase Inhibitors
41. Alpha-Blockers
42. Bladder Antispasmodics
43. Anticoagulants – Injectable
44. Colony Stimulating Factors
45. Platelet Inhibitors
46. Alpha-Glucosidase Inhibitors/Amylin Analogs/Misc.
47. Biguanides
48. Dipeptidyl Peptidase-4 Inhibitors
49. Meglitinides
50. Sulfonylureas
51. Thiazolidinediones
52. Growth Hormone Modifiers
53. Progestins For Cachexia
54. Antigout Agents
55. Bisphosphonates
56. Nasal Calcitonins
57. Restless Leg Syndrome Agents
58. Skeletal Muscle Relaxants
59. Alzheimer’s Agents
60. Barbiturates
61. Benzodiazepines
62. Hydantoins
63. Non-Ergot Dopamine Agonists
64. Carbonic Anhydrase Inhibitors/Beta-Blockers
65. Ophthalmic Prostaglandins
66. Ophthalmic Antihistamines
67. Ophthalmic Macrolides
68. Ophthalmic Quinolones
69. Ophthalmic Corticosteroids
70. Ophthalmic Nonsteroidal Antiinflammatory Drugs (NSAIDS)
71. Otic Quinolones
72. Antidepressants – Other
73. Selective Serotonin Reuptake Inhibitors (SSRIS)
74. Atypical Antipsychotics
Nevada Department of Health and Human Services
Helping People -- It's Who We Are And What We Do
September 28, 2015
Page 5
75. Nasal Antihistamines
76. Leukotriene Receptor Antagonists
77. Nasal Corticosteroids
78. Phosphodiesterase Type 4 Inhibitors
79. Respiratory Antimuscarinics
80. Long-Acting Respiratory Beta-Agonist
81. Short-Acting Respiratory Beta-Agonist
82. Respiratory Corticosteroid/Long-Acting Beta-Agonist
Combinations
83. Antidotes - Opiate Antagonists

5. Established Drug Classes

A. Antidepressants - Other
1.Public Comment
2.Drug Class Review Presentation – OptumRx
3.For Possible Action: Committee Discussion and Action
a. Approve Clinical/Therapeutic Equivalency of Agents in Class
b. Identify Exclusions/Exceptions for Certain Patient Groups
4.Presentation of Recommendations for Preferred Drug List (PDL)
Inclusion by OptumRx and the Division of Health Care Financing and
Policy
5.For Possible Action: Committee Discussion and Approval of Drugs for
Inclusion on the PDL

B. Nasal Antihistamines
1.Public Comment
2.Drug Class Review Presentation – OptumRx
3.For Possible Action: Committee Discussion and Action
a. Approve Clinical/Therapeutic Equivalency of Agents in Class
b. Identify Exclusions/Exceptions for Certain Patient Groups
4.Presentation of Recommendations for Preferred Drug List (PDL)
Inclusion by OptumRx and the Division of Health Care Financing and
Policy
5.For Possible Action: Committee Discussion and Approval of Drugs for
Inclusion on the PDL

C. Nasal Calcitonins
1.Public Comment
2.Drug Class Review Presentation – OptumRx
3.For Possible Action: Committee Discussion and Action
Nevada Department of Health and Human Services
Helping People -- It's Who We Are And What We Do
September 28, 2015
Page 6
a. Approve Clinical/Therapeutic Equivalency of Agents in Class
b. Identify Exclusions/Exceptions for Certain Patient Groups
4.Presentation of Recommendations for Preferred Drug List (PDL)
Inclusion by OptumRx and the Division of Health Care Financing and
Policy
5.For Possible Action: Committee Discussion and Approval of Drugs for
Inclusion on the PDL

D. Platelet Inhibitors
1.Public Comment
2.Drug Class Review Presentation – OptumRx
3.For Possible Action: Committee Discussion and Action
a. Approve Clinical/Therapeutic Equivalency of Agents in Class
b. Identify Exclusions/Exceptions for Certain Patient Groups
4.Presentation of Recommendations for Preferred Drug List (PDL)
Inclusion by OptumRx and the Division of Health Care Financing and
Policy
5.For Possible Action: Committee Discussion and Approval of Drugs for
Inclusion on the PDL

E. Bladder Antispasmodics
1.Public Comment
2.Drug Class Review Presentation – OptumRx
3.For Possible Action: Committee Discussion and Action
a. Approve Clinical/Therapeutic Equivalency of Agents in Class
b. Identify Exclusions/Exceptions for Certain Patient Groups
4.Presentation of Recommendations for Preferred Drug List (PDL)
Inclusion by OptumRx and the Division of Health Care Financing and
Policy
5.For Possible Action: Committee Discussion and Approval of Drugs for
Inclusion on the PDL

F. Angiotensin II Receptor Antagonists
1.Public Comment
2.Drug Class Review Presentation – OptumRx
3.For Possible Action: Committee Discussion and Action
a. Approve Clinical/Therapeutic Equivalency of Agents in Class
b. Identify Exclusions/Exceptions for Certain Patient Groups
Nevada Department of Health and Human Services
Helping People -- It's Who We Are And What We Do
September 28, 2015
Page 7
4.Presentation of Recommendations for Preferred Drug List (PDL)
Inclusion by OptumRx and the Division of Health Care Financing and
Policy
5.For Possible Action: Committee Discussion and Approval of Drugs for
Inclusion on the PDL

G. Immunomodulators: Topical
1.Public Comment
2.Drug Class Review Presentation – OptumRx
3.For Possible Action: Committee Discussion and Action
a. Approve Clinical/Therapeutic Equivalency of Agents in Class
b. Identify Exclusions/Exceptions for Certain Patient Groups
4.Presentation of Recommendations for Preferred Drug List (PDL)
Inclusion by OptumRx and the Division of Health Care Financing and
Policy
5.For Possible Action: Committee Discussion and Approval of Drugs for
Inclusion on the PDL

H. Ophthalmic Nonsteroidal Antiinflammatory Drugs (NSAIDs)
1.Public Comment
2.Drug Class Review Presentation – OptumRx
3.For Possible Action: Committee Discussion and Action
a. Approve Clinical/Therapeutic Equivalency of Agents in Class
b. Identify Exclusions/Exceptions for Certain Patient Groups
4.Presentation of Recommendations for Preferred Drug List (PDL)
Inclusion by OptumRx and the Division of Health Care Financing and
Policy
5.For Possible Action: Committee Discussion and Approval of Drugs for
Inclusion on the PDL

I. Disease-Modifying Antirheumatic Agents
1.Public Comment
2.Drug Class Review Presentation – OptumRx
3.For Possible Action: Committee Discussion and Action
a. Approve Clinical/Therapeutic Equivalency of Agents in Class
b. Identify Exclusions/Exceptions for Certain Patient Groups
4.Presentation of Recommendations for Preferred Drug List (PDL)
Inclusion by OptumRx and the Division of Health Care Financing and
Policy
Nevada Department of Health and Human Services
Helping People -- It's Who We Are And What We Do
September 28, 2015
Page 8
5.For Possible Action: Committee Discussion and Approval of Drugs for
Inclusion on the PDL

6. Established Drug Classes Being Reviewed Due to the Release of New Drugs

A. Alzheimer’s Agents
1.Public Comment
2.Drug Class Review Presentation – OptumRx
3.For Possible Action: Committee Discussion and Action
a. Approve Clinical/Therapeutic Equivalency of Agents in Class
b. Identify Exclusions/Exceptions for Certain Patient Groups
4.Presentation of Recommendations for Preferred Drug List (PDL)
Inclusion by OptumRx and the Division of Health Care Financing and
Policy
5.For Possible Action: Committee Discussion and Approval of Drugs for
Inclusion on the PDL

B. Oral Atypical Antipsychotics
1.Public Comment
2.Drug Class Review Presentation – OptumRx
3.For Possible Action: Committee Discussion and Action
a. Approve Clinical/Therapeutic Equivalency of Agents in Class
b. Identify Exclusions/Exceptions for Certain Patient Groups
4.Presentation of Recommendations for Preferred Drug List (PDL)
Inclusion by OptumRx and the Division of Health Care Financing and
Policy
5.For Possible Action: Committee Discussion and Approval of Drugs for
Inclusion on the PDL

C. Ophthalmic Antihistamines
1.Public Comment
2.Drug Class Review Presentation – OptumRx
3.For Possible Action: Committee Discussion and Action
a. Approve Clinical/Therapeutic Equivalency of Agents in Class
b. Identify Exclusions/Exceptions for Certain Patient Groups
4.Presentation of Recommendations for Preferred Drug List (PDL)
Inclusion by OptumRx and the Division of Health Care Financing and
Policy
5.For Possible Action: Committee Discussion and Approval of Drugs for
Inclusion on the PDL

Nevada Department of Health and Human Services
Helping People -- It's Who We Are And What We Do
September 28, 2015
Page 9
D. Short-Acting Respiratory Beta-Agonist
1.Public Comment
2.Drug Class Review Presentation – OptumRx
3.For Possible Action: Committee Discussion and Action
a. Approve Clinical/Therapeutic Equivalency of Agents in Class
b. Identify Exclusions/Exceptions for Certain Patient Groups
4.Presentation of Recommendations for Preferred Drug List (PDL)
Inclusion by OptumRx and the Division of Health Care Financing and
Policy
5.For Possible Action: Committee Discussion and Approval of Drugs for
Inclusion on the PDL

7. Report by OptumRx on New Drugs to Market, New Generic Drugs to Market, and
New Line Extensions

8. Closing Discussion

A. Public comments on any subject.

B. Date and location of the next meeting.

1.Discussion of the time of the next meeting.

C. Adjournment.

This notice and agenda have been posted at http://dhcfp.nv.gov and http://notice.nv.gov

Notice of this meeting will be available on or after the date of this notice at the DHCFP
Web site www.dhcfp.nv.gov, Carson City Central office and Las Vegas DHCFP. The
agenda posting of this meeting can be viewed at the following locations: Nevada State
Library; Carson City Library; Churchill County Library; Las Vegas Library; Douglas
County Library; Elko County Library; Lincoln County Library; Lyon County Library;
Mineral County Library; Tonopah Public Library; Pershing County Library; Goldfield
Public Library; Eureka Branch Library; Humboldt County Library; Lander County
Library; Storey County Library; Washoe County Library; and White Pine County
Library and may be reviewed during normal business hours.

If requested in writing, a copy of the meeting materials will be mailed to you. Requests
and/or written comments may be sent to Robyn Heddy at the Division of Health Care
Financing and Policy, 1100 E. William Street, Suite 101, Carson City, NV 89701, at least 3
days before the public hearing.

All persons that have requested in writing to receive the Public Hearings agenda have been
duly notified by mail or e-mail.
Nevada Department of Health and Human Services
Helping People -- It's Who We Are And What We Do
Division of Health Care Financing and Policy
Nevada Medicaid Preferred Drug List
Effective Sept. 1, 2015
Preferred Products PA Criteria Non-Preferred Products
Analgesics
Analgesic/Miscellaneous
Neuropathic Pain Agents
CYMBALTA® * PA Required GRALISE®
GABAPENTIN LIDODERM® *
LYRICA® HORIZANT®
Tramadol and Related Drugs
TRAMADOL CONZIPR®
TRAMADOL/APAP NUCYNTA®
RYZOLT®
RYBIX® ODT
TRAMADOL ER
ULTRACET®
ULTRAM®
ULTRAM® ER
Opiate Agonists
MORPHINE SULFATE SA TABS PA Required for Fentanyl AVINZA® QL
(ALL GENERIC EXTENDED Patch BUTRANS®
RELEASE) QL DOLOPHINE®
General PA Form: DURAGESIC® PATCHES QL
FENTANYL PATCH QL https://www.medicaid.nv.gov/D EMBEDA®
ownloads/provider/FA-59.pdf EXALGO®
HYSINGLA ER®
KADIAN® QL
METHADONE
METHADOSE®
MS CONTIN® QL
NUCYNTA® ER
OPANA ER®
OXYCODONE SR QL
OXYCONTIN® QL
OXYMORPHONE SR
XARTEMIS XR® QL
ZOHYDRO ER® QL
Antihistamines
H1 blockers
Non-Sedating H1 Blockers
CETIRIZINE D OTC A two week trial of one of ALLEGRA®
CETIRIZINE OTC these drugs is required CLARITIN®
LORATADINE D OTC before a non-preferred drug CLARINEX®
LORATADINE OTC will be authorized. DESLORATADINE
FEXOFENADINE
SEMPREX®
XYZAL®
PDL Exception PA: https://www.medicaid.nv.gov/Downloads/provider/FA-63.pdf
Chapter 1200 PA Criteria: http://dhcfp.nv.gov/
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